Therapeutic efficacy of granulocytapheresis in a pregnant woman with severe active ulcerative colitis: a case report

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  • Tsukada Yukiko
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Nakamura Makoto
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine
  • Nakao Masatsugu
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Suzuki Takahide
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Matsuo Nanae
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Yamamoto Ryo
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Hamaguchi Akihiko
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Hanaoka Kazushige
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Wakabayashi Yoshinori
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Ogura Makoto
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Yokoyama Keitaro
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine
  • Hosoya Tatsuo
    Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine

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Other Title
  • 顆粒球除去療法（ｇｒａｎｕｌｏｃｙｔａｐｈｅｒｅｓｉｓ：ＧＣＡＰ）の併用によって妊娠継続が可能になった潰瘍性大腸炎の１例
  • 症例報告 顆粒球除去療法(granulocytapheresis:GCAP)の併用によって妊娠継続が可能になった潰瘍性大腸炎の1例
  • ショウレイ ホウコク カリュウキュウ ジョキョ リョウホウ granulocytapheresis GCAP ノ ヘイヨウ ニ ヨッテ ニンシン ケイゾク ガ カノウ ニ ナッタ カイヨウセイ ダイチョウエン ノ 1レイ

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Abstract

We report a case of severe active ulcerative colitis in a pregnant woman receiving granulocytapheresis. The patient was a 35-year-old parous woman who had developed UC at the age of 24. She miscarried at 8 weeks during discontinuation of therapeutic agents when she was 30, and she had her first baby while receiving steroid therapy when she was 32. In July 2006, the patient was receiving oral prednisolone (PSL) 5 mg/day and mesalazine, and her UC activity was considered moderate according to the clinical activity index. However, the patient discontinued the drugs on her own judgment because of her pregnancy. At 8 weeks and 0 days pregnant, she was hospitalized because of diarrhea and hematochezia. We administered PSL 20 mg/day and treated her with bowel rest by fasting and intravenous hyperalimentation, but her symptoms did not improve. She also had rebound tenderness in the abdomen, which made us consider open abdominal surgery. We started intravenous administration of PSL 50 mg/day when she was 10 weeks and 2 days pregnant, and started to perform granulocytapheresis (GCAP) twice a week (a total of 10 sessions) when she was 11 weeks and 1 day pregnant. Her symptoms began to improve after the third GCAP session, and she developed remission by the fifth GCAP session. The dose of PSL was gradually reduced and the patient was discharged from the hospital on PSL 20 mg/day. The fetal biparietal diameter and femur length at day of discharge were both generally equivalent to those of a 16-week-old fetus. When concomitant GCAP was performed in a pregnant woman with UC that was difficult to treat, the patient showed prompt remission and could continue the pregnancy. GCAP, which has little influence on fetuses, should be used positively in pregnant women with UC in combination with conventional drug therapy.

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